If the work-in-progress that is the current U.S. healthcare system has accomplished anything for certain, it is this: Patients are now much more involved in the revenue cycle than ever before. The implementation of the Affordable Care Act (ACA) as well as the growth of high-deductible health plans, along with their companion payment vehicles known as Health Reimbursement Accounts and Health Savings Accounts, all have contributed to the current “patient consumerism” trend. This means that providers are seeing an increasing percentage of their reimbursement for services coming directly from patients rather than insurance plans. And for specialties like radiology, where direct provider/patient interaction is often limited, the entire service delivery process – encompassing billing processes as well – now entails unique challenges that must be addressed.

Maximizing the patient experience is no longer limited to the achievement of clinical outcomes. The new definition of patient satisfaction involves a deeper partnership with the provider – one that now places a greater focus on practice billing processes in line with the higher demands of today’s empowered patient. Successful practices are reviewing and fine-tuning their customer service policies and procedures as they relate to patient billing and collections, including the functions executed by outsourced billing vendors.

At Healthcare Administrative Partners (HAP), we’ve made a commitment to technology innovation as it sits at the core of enabling specialty physician practices to collect the maximum revenue they’ve earned. To that end, we implemented automated calling features in our patient support center, which has delivered growing benefits to both patients and practices. Here, we walk you through why it was necessary and how it tripled monthly payments.

For several years, we’ve partnered with 1-800 Notify, utilizing their automated calling technology in our operations center as an efficient means to communicate with patients regarding eligibility verification, returned mail, second billing statements, pre-collections notices and the like. And while such technology can be a major cost saver, we never lose sight of the need for human interaction. Our system is configured to notify us of exceptions consisting of automated calls that were concluded in less than two minutes without a transfer to a live operator, which is a potential red flag indicating the patient had problems during the call. HAP’s team then uses this data to execute live callbacks to ensure the patient is satisfied. All automated messages sent are recorded, allowing us to monitor patient interactions, adapt script messaging and correct any logic as needed.

In the spring of 2016, HAP began the first phase of a major new initiative aimed at improving patient collections via modernized automated calling processes. We started by working with 1-800 Notify to streamline the execution time of our automated calls regarding second billing statements – an important “crossroads” stage in the collections process where securing patient action is critical, and thus interaction with a live representative is often required. Custom programming enabled us to receive this daily call file and disperse the data so that the automated calls occurred more evenly throughout the day. This load leveling enabled us to staff call center agents more efficiently and reduced the chances that a patient listening to the automated call and then requesting live support would need to be placed on hold.

Shortly thereafter, we also implemented a pay-by-phone option within our automated calling technology, akin to what many consumers are now used to with retail purchases made via phone. Executing the process smoothly involved a custom systems integration that precluded the need for transferring the patient elsewhere once they opted to execute a credit card payment. To enhance collection rates, our new process utilized secure and direct communication with our payment processing vendor via HTTPS. This critical innovation enabled a continuation of the automated call within the host server from 1-800 Notify, thereby enabling patients to enter their credit card information and receive confirmation of the charge all in one seamless and quick call.

A core component of this system enhancement involved bridging a potential data gap specific to the patient statement files. With multiple business entities involved – HAP, 1-800 Notify, and InstaMed – sharing the data was necessary to enable the calling efficiency described above. However, in doing so, maintaining HIPAA compliance was obviously critical. Working as a team, experts from all companies pre-vetted and verified the data integrity of the solution (and we recommend doing the same as you consider similar solutions).

likewise, we also ascertained HIPAA and FDCPA compliance for a seemingly small, but very impactful addition to the script: mentioning the name of the medical practice or facility. Executing outbound calling to capture immediate payment is a challenge under any circumstance. Doing so without naming the entity that is requesting the payment is an exercise in futility and one that is liable to generate more patient complaints than payments. Again, our cross-company team of compliance experts verified that disclosing such information was indeed allowed by law.

This initial innovation phase concluded with the testing and deployment of IVR-enabled autopay. Within the first hour of making this feature live, six patients executed payments via the system without the involvement of our call center staff. From July through December 2016 – the first six months of full system deployment – roughly 111 patients completed their payment via the automated system each month, resulting in an average of $5,600 in monthly collections with zero dollars in associated direct call center staff support costs.

With these initial technology and compliance hurdles overcome, the door was open to realize major benefits of broader calling automation in the second phase of our initiative that started in the summer of 2016. Our next steps were to add the same IVR-enabled autopay features to the pre-collections courtesy calls – the “last chance” contact point with patients. Similar data file integrations were needed to reconfigure this specific call file with the required patient statement data. Initial testing of scripts revealed opportunities for process improvement. Customization branches were required in the logic to accommodate practice clients that accepted credit card payments as well as those that did not. A further system accommodation was made to accept partial payments based on the amount of credit available on the patient’s credit card. This ability of the system to dynamically verify and communicate credit limits to patients where credit card payments were allowed (and to route the script appropriately where credit card payments were not allowed) further enhanced the efficiency of the automated call system.

The third and final phase of our initiative began in spring 2017, when IVR payment options were added system-wide for all patients, including the mailed statements that prompt inbound patient calls. After going live in May, the IVR-enabled system captured 307 total transactions worth $18,262 in payments – triple the amount of the prior month. In June, total transactions jumped to 1,024, bringing in $63,545. None of those calls required staff involvement, enabling us to subsequently reduce costs by two FTEs. Currently, we are averaging 23 percent of total credit card payments being handled by the IVR-enabled system.

Concurrently, HAP worked with 1-800 Notify to enable and improve system features allowing varying payment amounts for those patients on installment plans. We programmed a minimum payment requirement of five dollars to prohibit patients from making miniscule payments on large balance accounts. If the balance owed is less than $10 (or some other minimum amount agreed upon with the client), the system logic will only allow full payment and not offer the choice to pay less than the full amount due. Additionally, recent system upgrades have enabled the ability to accept electronic check payments from patients via the IVR.

At present, we continue to refine and improve the system with the help of our partners at 1-800 Notify. We happily beta-tested these innovations, and after successful deployment with HAP and others, 1-800 Notify now offers them to their client base.

As the population of tech-friendly patients continues to age, HAP is committed to empowering our practice clients to meet their high and constantly changing expectations. We who manage the revenue cycle for these practices must remember that technology innovation will never – and should never – fully replace personal service when it comes to healthcare delivery. Automation of routine tasks in the payment process is an effective means of saving time and labor costs. Human interaction is still the best way to solve complex patient problems. The idea is to integrate and apply both intelligently for maximum provider and patient benefit. Today, we’re happy to report, that objective is achievable.